Barriers and facilitators of parental healthcare-seeking for sick young infants with possible serious bacterial infection in Ethiopia: a qualitative study using a socio ecological model.

backgroundEthiopia is among the countries with the highest number of newborn deaths globally. Despite the high mortality from treatable infectious conditions, many families do not seek care from health facilities. Therefore, this study explored the barriers and facilitators of care-seeking for sick infants in two districts in Ethiopia.

methodA qualitative descriptive study conducted among mothers to explore care-seeking practices for sick children in two districts, Ethiopia, from June 20 to August 30, 2025. We did total 21 interviews; ten in-depth interviews with mothers of infants and eleven key informant interviews with elders, health extension workers, program managers, and health workers. The data were analyzed using Open-Code software version 4.03. The data were thematically analyzed, where the Socio-Ecological Model (SEM) was applied as a theoretical framework to explore multilevel factors ranging from individual to policy contexts.

resultThe study showed that the individual-level factors, like perceptions and knowledge of the disease as not life-threatening, and danger signs, doubts about the effectiveness of medical care, and perceived poor service quality were identified as barriers. The interpersonal-level factors, including family support, spousal agreement, and influence from elders, relatives, neighbors, and community health workers, were identified as facilitators for care seeking. The community-level factors, including cultural norms and traditional or faith-based practices, hinder early care seeking, particularly in the early postnatal period. Distance to health facilities, limited availability of drugs, low facility readiness, and inadequate quality of care, were institutional-level factors that deterred timely facility-based care-seeking. In contrast, the availability of trained providers, adequate medical supplies, and well-equipped facilities facilitated timely care-seeking. At the policy or societal level, factors such as conflict and political instability, the cost of healthcare, and financial hardship hindered access to care.

conclusionCare-seeking for sick young infants is influenced by a complex interplay of individual, interpersonal, community, institutional, and societal factors. Addressing these multilevel barriers requires coordinated strategies to improve awareness, leverage social support, enhance service quality, and mitigate broader contextual challenges.